[Lumbar intervertebral disk operation in the aged].
The frequencies of required surgery of lumbar disc protrusion as the cause of resistant lumbar compression of the nerve root, including the rare cauda equina compression, is according to literature for patients over 70 years of age only 1% of the total number of lumbar disc surgery. However, probably as a course of the improved preclinical diagnostical methods as EMG, spinal CT scan, MRT and the increased number of these examination techniques the percentage was 3.2% in our material thus a higher share of operated patients at the age of 71 and older. 50% of those patients even had a sequestered lumbar disc protrusion. Because the additional, clinical relevant bone narrowment of the spinal canal, lateral processus and the foramina intervertebralia it is necessary for this group of patients to perform a wide microsurgical decompression as modification of the normal surgery with a sufficient resection of compressing bone parts through laminotomy, hemilaminectomie and laminectomy. We did not observe serious intra- and postsurgery complications with persistent damages. The surgical mortality of 68 consecutive operated patients at the age of 71 up to 93 years was zero. The subjective valuation of the surgical longterm results was in 68% of the interviewed patients well or excellent, including the influence of the presurgical torturing pain (66%) and clinically relevant neurological deficits (72%). 10.6% of all cases judged the long term results as insufficient or bad. Especially considering the increasing life expectation one should think of lumbar, even sequestered disc protrusion as the course of a therapy resistant lumbar compression of the nerve root and its successful surgical decompression of the older people before irreversible damages and torturing pains decrease the quality of life significantly.
von Wild
K
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Neurochirurgische Abteilung, Clemenshospital, Akademisches Lehrkrankenhaus, Westfälischen Wilhelms-Universität Münster.
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007796:Laminectomy / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D009408:Nerve Compression Syndromes / Q000601:surgery; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013126:Spinal Nerve Roots / Q000601:surgery
Zur lumbalen Bandscheibenoperation beim alten Menschen.